High Prevalence of Hepatitis B in People With HIV in the MWCCS, 2018–2024

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Background: This study aimed to examine the prevalence of hepatitis B virus (HBV) in people with HIV (PWH) undergoing contemporary antiretroviral therapy and people without HIV and to understand the risk factors in people with HIV/HBV coinfection. This retrospective cross-sectional study included 5238 participants with HIV or at risk for HIV acquisition across 13 US sites in the MACS/WIHS Combined Cohort Study (Multicenter AIDS Cohort Study / Women Interagency HIV Study) between January 2018 and December 2024. Methods: The primary outcome was the prevalence of HBV infection and HIV/HBV coinfection. We defined a positive HBsAg (surface antigen) as chronic HBV infection, a negative HBsAg and positive anti-HBV core antibody as recovered infection, and a negative HBsAg and negative anti-HBV core antibody as never infection. The prevalence of chronic and recovered HBV infection was described in different risk groups. Results: In this cohort, the overall prevalence of chronic HBV was 2.4%, and HIV/HBV coinfection was 3.0% among PWH. Current and prior HBV infection was more common in men, and the prevalence of prior HBV increased with age. As compared with the other 2 groups, PWH with chronic HBV infection had lower CD4+ T-cell counts (567 vs 651 and 689 cells/µL), CD4+ T-cell nadirs (210 vs 245 and 258 cells/µL), and HIV viral suppression rate (71.7% vs 82.3% and 83.7%). Among PWH who never had HBV infection, 40.6% lacked seroprotection against HBV. Conclusions: HBV is still prevalent in PWH. HBV coinfection was associated with lower CD4+ T-cell counts and viral suppression rate in PWH. The low seroprotection rate in those without HBV underscores the need for improved screening and immunization.

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